Study of Apixaban for the Prevention of Thrombosis-related Events in Patients With Acute Medical Illness
- Conditions
- Venous ThrombosisPulmonary Embolism
- Interventions
- Registration Number
- NCT00457002
- Lead Sponsor
- Bristol-Myers Squibb
- Brief Summary
The purpose of this study is to learn if apixaban can prevent blood clots in the leg (deep vein thrombosis \[DVT\]) and lung (pulmonary embolism \[PE\]) that sometimes occur within patients hospitalized for acute medical illness, and to learn how apixaban compares to enoxaparin (Lovenox®) for preventing these clots. The safety of apixaban will also be studied.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 6758
- men and non-pregnant, non-breastfeeding women
- 40 years or older
- hospitalized with congestive heart failure or acute respiratory failure
- infection (without septic shock)
- acute rheumatic disorder
- inflammatory bowel disease
- patients with venous thromboembolism (VTE)
- active bleeding or at high risk of bleeding
- unable to take oral medication
- with diseases requiring ongoing treatment with anticoagulants or antiplatelets other than aspirin at a dose ≤ 165 mg/day.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm 1 Apixaban While hospitalized, Apixaban plus Placebo Apixaban (Tablets, Oral, 2.5 mg), Placebo (Syringes, SC) After hospital discharge, Apixaban Apixaban (Tablets, Oral, 2.5 mg) Arm 2 Enoxaparin While hospitalized, Enoxaparin plus Placebo Enoxaparin (Syringes, SC, 40 mg), Placebo (Tablets, Oral) After hospital discharge: Placebo Placebo (Tablets, Oral)
- Primary Outcome Measures
Name Time Method Incidence of Composite of Adjudicated Total Venous Thromboembolism (VTE) and VTE-related Death During the Intended Treatment Period - Primary Efficacy Population Intended Treatment Period VTE: nonfatal pulmonary embolism (PE), symptomatic deep vein thrombosis (DVT), or asymptomatic proximal DVT detected by ultrasound. VTE-related death: fatal PE or sudden death for which VTE could not be excluded as a cause. Intended Treatment Period=period that started on day of randomization: period ended (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; period ended (for not treated) 32 days after randomization. A bilateral compression ultrasound (CUS) was performed between Days 5 and 14 for detection of asymptomatic proximal DVT unless a symptomatic VTE was confirmed prior. CUS was also performed on Day 30 ± 2 except for those participants who had a confirmed symptomatic VTE or proximal asymptomatic DVT prior to that time. All efficacy events were adjudicated by the Independent Central Adjudication Committee (ICAC). Event rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Major Bleeding During the Treatment Period in Treated Participants Day 1, first dose of study drug, to last dose of study drug plus 2 days Major bleeding was adjudicated by an ICAC using criteria from the International Society on Thrombosis and Hemostasis (ISTH) and was defined as acute clinically overt bleeding: associated with a fall in hemoglobin of 2 grams per deciliter (g/dL) or more, or leading to a transfusion of 2 or more units of packed red blood cells or 1000 milliliters (mL) or more of whole blood, or bleeding in a critical site or bleeding which is fatal. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Clinically Relevant Non-Major (CRNM) Bleeding During the Treatment Period in Treated Participants Day 1, first dose of study drug, to last dose of study drug plus 2 days Bleeding was adjudicated by an ICAC using criteria from the ISTH. CRNM bleeding: acute clinically overt bleeding compromising hemodynamics; leading to hospitalization; traumatic subcutaneous hematoma; intramuscular hematoma; epistaxis that lasted for more than 5 minutes, was repetitive or led to an intervention; spontaneous gingival bleeding; spontaneous hematuria; macroscopic gastrointestinal hemorrhage (including at least 1 episode of melena or hematemesis, if clinically apparent with positive results on a fecal occult-blood test); rectal blood loss. Treatment Period=includes measurements or events with onset from first dose of study drug through 2 days after the last dose of study drugs for bleeding endpoints. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Composite of Major or Clinically Relevant Non-Major (CRNM) Bleeding During the Treatment Period in Treated Participants Day 1, first dose of study drug, to last dose of study drug plus 2 days Bleeding was adjudicated by an ICAC using criteria from the ISTH. Major bleeding: acute clinically overt bleeding: associated with a fall in hemoglobin of 2 g/dL or more, or leading to a transfusion of 2 or more units of packed red blood cells or 1000 mL or more of whole blood, or bleeding in a critical site or bleeding which is fatal. CRNM bleeding: acute clinically overt bleeding compromising hemodynamics; leading to hospitalization; traumatic subcutaneous hematoma; intramuscular hematoma; epistaxis that lasted for more than 5 minutes, was repetitive or led to an intervention; spontaneous gingival bleeding; spontaneous hematuria; macroscopic gastrointestinal hemorrhage; rectal blood loss. Treatment Period=onset from first dose of study drug through 2 days after last dose of study drugs. Incidence: Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of All Bleeding During the Treatment Period in Treated Participants Day 1, first dose of drug to last dose of drug plus 2 days Bleeding was adjudicated by an ICAC using criteria from the ISTH. Treatment Period=includes measurements or events with onset from first dose of study drug through 2 days after the last dose of study drugs, for bleeding endpoints. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
- Secondary Outcome Measures
Name Time Method Incidence of Adjudicated VTE-Related Death With Onset During the Intended Treatment Period in Randomized Participants Intended Treatment Period Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. VTE-related death: fatal PE or sudden death for which VTE cannot be excluded as a cause. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Adjudicated Symptomatic VTE or All-Cause Death With Onset During the Intended Treatment Period Intended Treatment Period Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. VTE: nonfatal PE, symptomatic DVT, or asymptomatic proximal DVT detected by ultrasound. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Adjudicated Total VTE and VTE-Related Death During Parenteral Treatment in Key Secondary Efficacy Evaluable Participants Day 1 to last dose of parenteral study drug plus 1 day Parenteral study drug=active or placebo enoxaparin. Parenteral treatment: started on the first dose of parenteral study drug and ended the day after the last dose of parenteral study drug. Key Secondary Efficacy population: all who received at least 1 dose of parenteral study drug and: (those without suspected VTE events during Parenteral Treatment) had an adjudicated evaluable ultrasound performed at the end of Parenteral Treatment; or (those with suspected VTE events during Parenteral Treatment) had those suspected VTE events adjudicated as non-events, and had an adjudicated evaluable ultrasound performed at the end of Parenteral Treatment; or had an adjudicated total VTE during Parenteral Treatment; or had an adjudicated VTE-related death during Parenteral Treatment. Event rate (%): n/N\*100 (n=number with observation; N=total secondary efficacy evaluable participants).
Incidence of Adjudicated Total VTE and VTE-Related Death During Parenteral Treatment in Secondary Efficacy Evaluable Participants Day 1 to last dose of parenteral study drug plus 1 day Parenteral study drug=active or placebo enoxaparin. Parenteral treatment: started on the first dose of parenteral study drug and ended the day after the last dose of parenteral study drug. Secondary Efficacy Evaluable includes those who had an adjudicated, evaluable ultrasound at end of parenteral treatment and for those with a suspected symptomatic event, the result of the adjudication for the symptomatic event was not inadequate; or those with an adjudicated event that was part of the composite endpoint.. Event rate (%): n/N\*100 (n=number with observation; N=total secondary efficacy evaluable participants).
Incidence of Adjudicated Total VTE or All-Cause Death With Onset During the Intended Treatment Period Intended Treatment Period Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. VTE: nonfatal (N-F) PE, symptomatic DVT, or asymptomatic proximal DVT detected by ultrasound. VTE-related death: fatal PE or sudden death for which VTE cannot be excluded as a cause. All-Cause Death (A-C Death). Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Adjudicated Proximal DVT, Non-Fatal PE or All-Cause Death With Onset During the Intended Treatment Period Intended Treatment Period Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Mean Change From Baseline in Systolic Blood Pressure in Treated Participants During Treatment Period Day 1 to last dose of study drug plus 2 days Systolic blood pressure was obtained during Screening/Enrollment Visit (Day 1, prior to drug being administered), on the day of hospital discharge, Day 30 (last day of treatment) plus 2 days. Blood pressure was measured in millimeters of mercury (mmHg) and could have been taken either sitting, standing, or supine.
Mean Change From Baseline in Heart Rate in Treated Participants Day 1 to last dose of study drug plus 2 days Heart Rate was obtained during Screening/Enrollment Visit (Day 1, prior to drug being administered), on the day of hospital discharge, Day 30 (last day of treatment) plus 2 days. Heart rate was measured in beats per minute (bpm) and could have been taken with participants either sitting, standing, or supine.
Number of Participants With Marked Abnormalities in Hematology Laboratory Tests During Treatment Period in Treated Participants Day 1 to last dose of study drug plus 2 days Lower limit of normal (LLN). Upper limit of normal (ULN). Pre-therapy (PreRx). Absolute (Abs) neutrophil count, bands + neutrophils (ANC). Cells per microliter (c/µL). Grams per deciliter (g/dL). Cells per Liter (c/L). Millimeter (MM). Absolute (Abs). Hemoglobin: \>2 g/dL decrease compared to PreRx value or value \<=8 g/dL; Hematocrit: \<0.75\*PreRx; Erythrocytes: \<0.75\*PreRx c/µL; Leukocytes: \<0.75\*LLN or \> 1.25\*ULN, if PreRx \<LLN then use \<0.8\*PreRx or \>ULN, if PreRx \>ULN then use \>1.2\*PreRx or \< LLN; Platelet count: \< 100\*10\^9 c/L; ANC: \< 1.00\*10\^3 c/µL; Abs eosinophils: \> 0.75\*10\^3 c/µL; Abs Basophils: \> 400/MM\^3; Abs Monocytes \> 2000/MM\^3; Abs Lymphocytes: \< 0.750\*10\*3 c/ µL or \> 7.5\*10\^3 c/ µL. Samples were obtained at Screening/Enrollment Visit (Day 1, prior to drug being administered), on the day of hospital discharge, Day 30 (last day of treatment) plus 2 days.
Number of Participants With Marked Abnormalities in Electrolyte Laboratory Tests During Treatment Period in Treated Participants Day 1 to last dose of study drug plus 2 days Bicarbonate milliequivalents/Liter (mEq/L) Low/High: \< 0.75\*LLN or \> 1.25\*ULN, or if PreRx \< LLN then use \< 0.75\* PreRx or \> ULN if PreRx \> ULN then use \> 1.25\*PreRx or \< LLN; Serum Calcium mg/dL Low/High: \< 0.8\*LLN or \> 1.2\*ULN, or if PreRx \< LLN then use \< 0.75\*PreRx or \> ULN if PreRx \> ULN then use \> 1.25\*PreRx or \< LLN; Serum Chloride mEq/L: \< 0.9\*LLN or \> 1.1\*ULN, or if PreRx \< LLN then use \< 0.9\*PreRx or \> ULN if PreRx \> ULN then use \> 1.1\*PreRx or \< LLN; Serum Potassium mEq/L: \< 0.9\*LLN or \> 1.1\*ULN, or if PreRx \< LLN then use \< 0.9\*PreRx or \> ULN if PreRx \> ULN then use \> 1.1\*PreRx or \< LLN; Serum Sodium mEq/L: \< 0.95\*LLN or \> 1.05\*ULN, or if PreRx \< LLN then use \< 0.95\*PreRx or \> ULN if PreRx \> ULN then use \> 1.05\*PreRx or \< LLN. Samples obtained at Screening/Enrollment Visit (Day 1, prior to drug being administered), on the day of hospital discharge, Day 30 (last day of treatment) plus 2 days.
Number of Participants With Marked Abnormalities in Kidney and Liver Function Laboratory Tests During the Treatment Period in Treated Participants Day 1 to last dose of study drug plus 2 days Blood urea nitrogen (BUN), milligrams/deciliter (mg/dL), units per liter (U/L). BUN mg/dL \> 1.5\*ULN; Creatinine mg/dL: \> 1.5\*ULN; Alanine aminotransferase (ALT) U/L: \> 3\*ULN; Aspartate aminotransferase (AST) U/L: \> 3\*ULN; Alkaline phosphatase U/L: \> 2\*ULN; Bilirubin Direct mg/dL: \> 1.5\*ULN; Bilirubin Total mg/dL: \> 2\*ULN. Samples for laboratories obtained at Screening/Enrollment Visit (Day 1, prior to drug being administered), on the day of hospital discharge, Day 30 (last day of treatment) plus 2 days.
Incidence of Adjudicated Proximal DVT, Non-Fatal PE or VTE-Related Death, With Onset During the Intended Treatment Period Intended Treatment Period Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. VTE-related death: fatal PE or sudden death for which VTE cannot be excluded as a cause. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Symptomatic Adjudicated VTE or VTE-Related Death With Onset During the Intended Treatment Period Intended Treatment Period Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. VTE: nonfatal PE, symptomatic DVT, or asymptomatic proximal DVT detected by ultrasound. VTE-related death: fatal PE or sudden death for which VTE cannot be excluded as a cause. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of All VTE or Major Bleeding or All-Cause Death During the Intended Treatment Period Intended Treatment Period Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. VTE: nonfatal PE, symptomatic DVT, or asymptomatic proximal DVT detected by ultrasound. VTE-related death: fatal PE or sudden death for which VTE cannot be excluded as a cause. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Adjudicated PE With Onset During the Intended Treatment Period Intended Treatment Period Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. PE: non-fatal or fatal. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Adjudicated Non-Fatal PE With Onset During the Intended Treatment Period Intended Treatment Period Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Adjudicated Symptomatic DVT With Onset During the Intended Treatment Period Intended Treatment Period Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Adjudicated Proximal DVT With Onset During the Intended Treatment Period Intended Treatment Period Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. A bilateral compression ultrasound (CUS) was performed between Days 5 and 14 for detection of asymptomatic proximal DVT unless a symptomatic VTE was confirmed prior. CUS was also performed on Day 30 ± 2 except for those participants who had a confirmed symptomatic VTE or proximal asymptomatic DVT prior to that time. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Adjudicated Symptomatic Distal DVT With Onset During the Intended Treatment Period Intended Treatment Period Events were adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Adjudicated Symptomatic Proximal DVT With Onset During the Intended Treatment Period Intended Treatment Period Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. A bilateral compression ultrasound (CUS) was performed between Days 5 and 14 for detection of asymptomatic proximal DVT unless a symptomatic VTE was confirmed prior. CUS was also performed on Day 30 ± 2 except for those participants who had a confirmed symptomatic VTE or proximal asymptomatic DVT prior to that time. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Incidence of Adjudicated Asymptomatic Proximal DVT With Onset During the Intended Treatment Period Intended Treatment Period A bilateral compression ultrasound (CUS) was performed between Days 5 and 14 for detection of asymptomatic proximal DVT unless a symptomatic VTE was confirmed prior. CUS was also performed on Day 30 ± 2 except for those participants who had a confirmed symptomatic VTE or proximal asymptomatic DVT prior to that time. Events adjudicated by ICAC. Intended Treatment Period=period that starts on day of randomization: period ends (for treated) at latter of a) 2 days after last dose of study drug and b) 32 days after first dose of study drug; (for not treated) period ends 32 days after randomization. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants).
Number of Participants With Adverse Events (AEs), Serious AEs (SAEs), Bleeding AEs, Deaths, and Discontinuations Due to AEs During the Treatment Period in Treated Participants Day 1, first dose of study drug, to last dose of study drug plus 2 days (AEs), plus 30 days (SAEs, Deaths) Treatment Period=includes measurements or events with onset from first dose of study drug through 2 days after the last dose of study drugs for AEs, and 30 days after last dose of study drugs for SAEs and deaths.
Mean Change From Baseline in Diastolic Blood Pressure in Treated Participants During Treatment Period Day 1 to last dose of study drug plus 2 days Diastolic blood pressure was obtained during Screening/Enrollment Visit (Day 1, prior to drug being administered), on the day of hospital discharge, Day 30 (last day of treatment) plus 2 days. Blood pressure was measured in millimeters of mercury (mmHg) and could have been taken with the participant either sitting, standing, or supine.
Number of Participants With Marked Abnormalities in Glucose, Creatine Kinase, Uric Acid, and Total Protein Laboratory Tests During the Treatment Period in Treated Participants Day 1 to last dose of study drug plus 2 days Creatine kinase High: \>5\*ULN Units/Liter (U/L); Total Protein High/Low: \< 0.9 \*LLN or \> 1.1\*ULN, or if PreRx \< LLN then use 0.9\* PreRx or \> ULN if PreRx \> ULN then use 1.1 \*PreRx or \<LLN; Uric acid High: \> 1.5\* ULN, or if PreRx \> ULN then use \> 2 \*PreRx. Glucose Fasting: \<0.9\*LLN or \> 1.5\*ULN or if PreRx \< LLN then use \< 0.8\*PreRx or \> ULN, if PreRx \> ULN then use \>2.0\*PreRx. Samples obtained at Screening/Enrollment Visit (Day 1, prior to drug being administered), on the day of hospital discharge, Day 30 (last day of treatment) ± 2days.
Incidence of Events of Special Interest of Adjudicated Myocardial Infarction, Stroke, and Thrombocytopenia During the Treatment Period in Treated Participants Day 1 to last dose of study drug plus 2 days Events of Special Interest include: adjudicated thrombocytopenia, adjudicated myocardial infarction (MI), adjudicated stroke, and adjudicated MI or stroke. Incidence determined by Event Rate (%): n/N\*100 (n=number with observation; N=total efficacy evaluable participants). Treatment Period includes measurements or events with onset from first dose of study drug through 2 days after the last dose of study drugs.
Number of Participants With Events of Special Interest for Liver Function and Neurology During Treatment Period in Treated Participants With Available Measurements Day 1 to last dose of study drug plus 2 days (AEs) and plus 30 days (SAEs) Special interest include: liver function test increases, AEs related to liver function, and neurologic AEs. Treatment Period includes measurements or events with onset from first dose of study drug through 2 days after the last dose of study drug when summarizing AEs and through 30 days after the last dose when summarizing SAEs.
Number of Participants With Liver-Related Elevations During the Treatment Period in Treated Participants Day 1 to last dose of study drug plus 2 days Liver function tests: Alanine aminotransferase (ALT) U/L; Aspartate aminotransferase (AST) U/L; Alkaline phosphatase U/L; Total Bilirubin (TBili) mg/dL. Elevations consist of \>3\*Upper Limit of Normal (ULN) for ALT and AST and elevation of \>2\*ULN for Bilirubin.
Trial Locations
- Locations (48)
Pulmonary & Critical Care Of Atlanta
🇺🇸Atlanta, Georgia, United States
Atlanta Institute For Medical Research, Inc
🇺🇸Atlanta, Georgia, United States
Johns Hopkins University School Of Medicine
🇺🇸Baltimore, Maryland, United States
University Of Missouri-Columbia
🇺🇸Columbia, Missouri, United States
Franklin Square Hospital
🇺🇸Baltimore, Maryland, United States
North Shore University Hospital
🇺🇸Manhasset, New York, United States
Research Alliance, Inc.
🇺🇸Clearwater, Florida, United States
Pensacola Lung Group
🇺🇸Pensacola, Florida, United States
Heart Center Research, Llc
🇺🇸Huntsville, Alabama, United States
Az Pulmonary Specialists Ltd
🇺🇸Scottsdale, Arizona, United States
Fort Smith Lung Center
🇺🇸Fort Smith, Arkansas, United States
Scripps Clinic/Scripps Health And Green Hospital
🇺🇸La Jolla, California, United States
Va Long Beach Healthcare System
🇺🇸Long Beach, California, United States
Univ. Of Southern Calif. /Norris Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Stanford University
🇺🇸Stanford, California, United States
George Washington University
🇺🇸Washington, District of Columbia, United States
Norwalk Hospital
🇺🇸Norwalk, Connecticut, United States
Jacksonville Center For Clinical Research
🇺🇸Jacksonville, Florida, United States
Indian River Med. Ctr.
🇺🇸Vero Beach, Florida, United States
Idaho Falls Infectious Diseases, Pllc
🇺🇸Idaho Falls, Idaho, United States
West Suburban Hospital
🇺🇸Oak Park, Illinois, United States
Louisiana State University Health Sciences Center-Shreveport
🇺🇸Shreveport, Louisiana, United States
Infectious Disease Of Indiana Psc
🇺🇸Carmel, Indiana, United States
Mercury Street Medical Group, Pllc
🇺🇸Butte, Montana, United States
Henry Ford Hospital, Transplant Institute
🇺🇸Detriot, Michigan, United States
Morristown Memorial Hospital
🇺🇸Mornstown, New Jersey, United States
Staten Island University Hospital
🇺🇸Staten Island, New York, United States
The Milton S Hershey Medical Center Of Penn. State Univ.
🇺🇸Hershey, Pennsylvania, United States
Mission Hospital, Inc
🇺🇸Asheville, North Carolina, United States
Lehigh Valley Hospital
🇺🇸Allentown, Pennsylvania, United States
Palmetto Nephrology Pa
🇺🇸Orangeburg, South Carolina, United States
S. Carolina Pharmaceutical Research
🇺🇸Spartanburg, South Carolina, United States
Texas Health Presbyterian Dallas
🇺🇸Dallas, Texas, United States
Michael E. De Bakey Veteran Affairs Medical Center
🇺🇸Houston, Texas, United States
Intermountain Medical Center
🇺🇸Murray, Utah, United States
Mcguire Va Medical Center
🇺🇸Richmond, Virginia, United States
Local Institution
🇬🇧Hull, Yorkshire, United Kingdom
Cotton-O-Neil Clinical Research Center
🇺🇸Topeka, Kansas, United States
Thomas Jefferson University
🇺🇸Philadelphia, Pennsylvania, United States
University Of Alabama At Birmingham Hospital
🇺🇸Birmingham, Alabama, United States
Arizona Pulmonary Specialists, Ltd.
🇺🇸Phoenix, Arizona, United States
Creighton University Medical Center
🇺🇸Omaha, Nebraska, United States
South Oklahoma Heart Research
🇺🇸Oklahoma City, Oklahoma, United States
Sonterra Clinical Research
🇺🇸San Antonio, Texas, United States
University Of Utah Medical Center
🇺🇸Salt Lake City, Utah, United States
Dr. Felt Medical Office
🇺🇸Oakland, California, United States
Yale University School Of Medicine
🇺🇸New Haven, Connecticut, United States
Florida Hospital Celebration Health
🇺🇸Celebration, Florida, United States